Smoking and postoperative outcomes in elective cranial surgery

Clinical article

Nima Alan B.S. 1 , Andreea Seicean Ph.D., M.P.H. 1 , 2 , Sinziana Seicean M.D., M.P.H., Ph.D. 3 , 4 , Nicholas K. Schiltz Ph.D. 2 , Duncan Neuhauser Ph.D. 2 , and Robert J. Weil M.D. 5
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  • 1 Case Western Reserve University School of Medicine, Cleveland;
  • 2 Department of Epidemiology and Biostatistics, Case Western Reserve University;
  • 3 Departments of Pulmonary, Critical Care, and Sleep Medicine, University Hospitals, Cleveland;
  • 4 Heart and Vascular Institute, Cleveland Clinic; and
  • 5 The Rose Ella Burkhardt Brain Tumor & Neuro-Oncology Center, and Department of Neurosurgery, the Neurological Institute, Cleveland Clinic, Cleveland, Ohio
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Object

The goal in this study was to assess whether a current or prior history of smoking and the number of smoking pack years affect the risk for adverse outcomes in the 30-day postoperative period in patients who undergo elective cranial surgery.

Methods

Data from the 2006–2011 American College of Surgeons' National Surgical Quality Improvement Project were used in this study. The authors identified 8296 patients who underwent elective cranial surgery, of whom 1718 were current smokers, 854 were prior smokers, and 5724 were never smokers. Using propensity scores and age, the authors matched current and prior smokers to never smokers. Odds ratios for adverse postoperative outcomes were predicted with logistic regression. The relationship between number of pack years and poor outcomes was also examined.

Results

In unadjusted analyses, prior and current smokers did not differ from never smokers for having poor outcomes postoperatively. Similarly, in matched analyses, no association was found between smoking and adverse outcomes. Number of pack years in propensity-matched analyses did not predict worse outcomes in prior or current smokers versus never smokers.

Conclusions

The authors did not find smoking to be associated with 30-day postoperative morbidity or mortality. Although smoking cessation is beneficial for overall health, it may not improve the short-term (≤ 30 days) outcome of elective cranial surgery. Thus postponement of elective cranial cases only for smoking cessation may not be necessary.

Abbreviations used in this paper:ACS = American College of Surgeons; BMI = body mass index; BUN = blood urea nitrogen; CPT = Current Procedure Terminology; IQR = interquartile range; LOS = length of stay; NSQIP = National Surgical Quality Improvement Program; OR = operating room; SAH = subarachnoid hemorrhage.

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Contributor Notes

Address correspondence to: Nima Alan, B.S., c/o ND4-40 LRI/Cleveland Clinic, 9500 Euclid Ave., Cleveland, OH 44195. email: nima.alan@gmail.com.

Please include this information when citing this paper: published online February 14, 2014; DOI: 10.3171/2014.1.JNS131852.

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